Title-Persistent Barriers at provider level for immediate post-placental IUD among Pakistani women. 

 Objective- To determine what persistent barriers exist at the provider level while providing immediate post-placental intrauterine device (PPIUD) in Pakistani women.

Methods-767 eligible women included in cross sectional study, conducted at Rawalpindi teaching hospital Pakistan.

Demographic details,consent, reasons for declining PPIUD insertion or early removal recorded

3 follow up visits scheduled at 6 weeks,3 months & 6 months.

Results-

64.2% had vaginal & 35.7% by cesarean birth,Mean age was-28.45±3.04years, 63 (8.21%) no formal education

114(14.6%) very low socio economic status group,only (69.8%) reported physically, (30.1%) on phone.

 At 6 weeks, 709 ( 92.4%) ,IUD retained,At 3 month, 635 (82.7%),At 6 month 531(69.2%) 

Main reasons for refusal / early removal of PPIUCD

1. Misconception, about future fertility    217 28.2%)
2. Considered non -religious practice      138 (18.1%)
3. Fear of bleeding & perforation               71 (9.25%)
4. Partner or elder family opposition        213 (27.7%)
5. Past unpleasant experience                 181 (23.5%)
6. Satisfaction with pre-existing method   172 (22.4%)
7. Preference for early family completion 110 (14.3%)
8. Desire for alternative method                 89 (11.6%)
9. Perceived lack of choice                         89(11.6%).
10. no reason provided                          84 (10.9%)

Conclusions

1. Respect Choices: Prioritize women’s preferences in contraception
2. Empower Women: Educate and involve families for sustainable decisions.
3. Strengthen Training: Equip health workers with counseling skills and commitment to follow-up.
4. Offer Alternatives: Suggest other LARC or interval IUCD for those unwilling

Key words-Post-placental IUD, LARC, contraception, Pakistani women.

References

1. Shumaila hamid et al. . Antenatal Counselling: Does it Boost the Uptake of Post Placental Intrauterine Contraceptive Device?Journal of society of obstetricians and gynaecologist of Pakistan.vol12,No 2(2022).April-June

        2. Erica Holland ¹, L Daniela Michelis ², Sarita Sonalkar ³, Christine L Curry ⁴Barriers to Immediate Post-placental

            Intrauterine Devices among Attending Level Educators. Womens Health Issues. 2015 Jul-Aug;25(4):355-8. doi: 1

            0.1016/j. whi.2015.03.013. Epub 2015 Jun 3.PMID: 26048758 DOI: 10.1016/j.whi.2015.03.013